The Affordable Care Act

The election is over and Barack Obama has won a second term. Although many people may have been hedging their bets, waiting on the outcome of the election, the Affordable Care Act is here to stay. What does this mean for Medicare, healthcare institutions, healthcare workers and the general public? As nurses, we care for our patients regardless of insurance status, but we all know that insurance is a major issue for many of our patients. Keeping in mind that some of the key features won’t be implemented until 2014, here are some of the highlights of the Act and how they will affect individuals and corporate entities:

Health insurance: At the present time, no one is required to have health insurance, but by 2014 this will change. Most individuals will be required to have health insurance or face a fine of up to 1% of their income (or $95 per year, whichever is greater). By 2016 the fine will rise to 2.5% of income or $695, whichever is greater. For families, the penalty for not having insurance will be 2.5% of the combined household income. However, these requirements could be waived when financial hardship is an issue. Some states have passed laws to block the necessity of carrying health insurance; however, federal law supersedes state law. Many more people are expected to be eligible for Medicaid or will be able to access federal subsidies to buy health insurance.

Current health insurance plans: For those individuals who already have insurance through their current employer, it is possible that nothing will change. However, employers may change premiums, network coverage, co-pay amounts and deductibles, just as they could before the Affordable Care Act. Some of the effects of the Affordable Care Act have already been enacted; for example, lifetime coverage limits have now been banned, and adult children (up to the age of 26) who don’t have health insurance through work can stay on their parent’s plan.

Medicaid: For people who want health insurance but can’t afford it, starting in 2014 the federal government is offering to expand the Medicaid program so that individuals and families who earn incomes at or lower than 133% of the federal poverty level will be eligible for this benefit. This is not yet a hard-and-fast law — the governors of several states, such as Alabama, have stated that they will refuse the expansion of Medicaid and the Supreme Court has ruled that states cannot be mandated into making this change to Medicaid. For people who earn too much money for Medicaid but still can’t afford health insurance, government subsidies will be put in place to allow them to purchase insurance from state-based exchanges, which will sell insurance to small businesses and individuals.

Seniors: Changes to the Medicare Part D prescription plan will mean that seniors will only be required to pay for 25% of their prescription costs, without a certain initial cost to be paid first before coverage begins. Preventive services will be expanded and seniors will be allowed a free annual wellness visit.

- Coverage cannot be cancelled if you become ill (known as rescission)

- Coverage for pre-existing conditions cannot be refused (for children this is already the case, for adults will be enacted by 2014)

- Rebates to be provided to customers if they spend less than 80-85% of premium dollars on medical care

Like it or hate it, agree or disagree, the Affordable Care Act is here to stay. Although there is apt to be some confusion over the next two years, as well as some contention as the last kinks in the plan get worked out between Democrats and Republicans, the end result will be that most people will have health insurance by 2014.